Paper short abstract

This paper discusses the tension between access to TB treatment as a human right in a context of underfinanced health systems and the risk that large-scale distribution of antibiotics contributes to a transition from a treatable TB epidemic to a increasingly untreatable XDR-TB epidemic.

Paper long abstract

New public health funding mechanisms with global reach have dramatically changed the funding mechanisms of global public health, and they have changed what is to be funded, involving a shift from prevention to medical treatment. At the same time, access to treatment - especially ARV for HIV infection - had been successfully defined as a human rights issue. In 1993, WHO declared that TB presented a global health emergency and it became the focus of a separate vertical public health program, known as DOTS (directly observed treatment - short-course). Initially funded by the World Bank, bilateral donors and governments in high prevalence countries, and subsequently by the Global Fund, DOTS was a very ambitious public health programme in terms of its requirements for infrastructure, supervision, monitoring, delivery and diagnosis. It aimed for 70% case-detection and 85% treatment success rates; these cut-off points were expected to reduce prevalence by half within a decade in omplementing countries. Despite subsequent revisions of the strategy, the impact on TB prevalence in a high-prevalence country like India was marginal, whereas the country has seen the development of a new epidemic of multi-drug resistant TB (MDRTB). This situation leaves global health policy with a difficult the tension between access to TB treatment as a human right in a context of underfinanced health systems and the risk that large-scale distribution of antibiotics over a few decades will contribute to a transition from a treatable TB epidemic to a increasingly untreatable extensively drug-resistant TB (XDRTB) epidemic.